Finding a Cure for Insomnia: A Review of Common Treatments
American Academy of Sleep Medicine
Clinical Practice Review Committee
Many different products are sold in stores and online for the treatment of insomnia. Not all of them deliver on their promise to help you get a good night's sleep. Take a closer look at what works and what doesn't.
Insomnia is the most common sleep complaint in the U.S. It affects from 10% to 35% of people at least some of the time. The true rate depends upon how you define this disorder. Insomnia keeps people from sleeping well and feeling refreshed. This happens in the four different ways that follow:
- Difficulty falling asleep
- Difficulty staying asleep
- Waking up too early
- Poor quality of sleep
People with insomnia often feel tired and grumpy. They can have a hard time remembering things. It is also hard for them to focus on what they are doing. A lack of sleep can also affect how they function at work and while driving. Overall, it makes people frustrated when it comes to their sleep. Insomnia can be the only source of these problems. It can also be the result of another sleep disorder or medical problem.
Insomnia may be caused by some types of medications. Even medicines that you find on drugstore shelves can disrupt sleep. Insomnia can be made worse by the use of caffeine or alcohol. It can even be a result of well-intentioned behaviors such as napping. It can also be related to depression, worry and stress. Before treating insomnia, a doctor must first do a medical exam. He or she may also need to perform some tests.
Doctors often treat insomnia in the three ways that follow:
1. Sleep hygiene
Sleep hygiene consists of basic habits and tips that help you develop a pattern of healthy sleep. Examples include getting up at the same time every day and avoiding caffeine after lunch.
2. Cognitive behavioral therapy
This involves relaxation exercises and other methods that help improve your sleep. Some people listen to relaxing tapes. Others learn breathing exercises from a psychologist. Other methods teach you to do things such as limiting the time you spend in bed.
3. Sleeping pills and sleeping aids
Doctors sometimes prescribe sleeping pills to treat insomnia. These are called hypnotics. At times insomnia is related to depression and anxiety. In these cases, medications may be prescribed by doctors to help insomnia.
Some people with insomnia try to treat themselves with nonprescription sleep aids that they find on drugstore shelves. Others may try vitamins or herbs. Some people even use alcohol to help them fall asleep. Doing this actually makes their sleep worse. The alcohol causes them to wake up during the night.
There are many ways to treat insomnia that are common and effective. You should talk to your primary care doctor to discuss these options. You may also want to visit a sleep center to get more expert advice. You should see a sleep specialist if your insomnia causes you to nod off during the day. There are a number of products sold for the treatment of insomnia. They can be bought off the shelf at a drug store without a prescription. Some of the items do have ingredients that can help improve insomnia.
Most items, however, have very little proof that they really work. The research to support the use of these products is poor. Problems with these studies include the following:
- Small numbers of patients were studied.
- There is little information about the types of patients who use the products.
- The studies do not use a control group who get a placebo drug. A placebo is simply a sugar pill that really has no medicine. It is used to see if patients think they feel better just because they took a pill.
- Most of the data for the studies is not reliable. It depends too much on the patient to report any changes in how he feels. A good study should have specific data that shows changes in the quality of a patient’s sleep.
- Studies have only looked at short-term treatment. They only cover a few days or weeks. It is not known if using these products over a long period of time is either safe or helpful.
- These products are not always safe. Some have harmful or dangerous side effects. Some can cause problems when taken with other medicines.
- Some products are not regulated by the U.S. Food and Drug Administration (FDA). This includes melatonin and herbs. The quality and quantity of substances in these products may not have been checked.
This summary takes a closer look at some of the most popular products used to treat insomnia. They are advertised to be helpful for people who have insomnia.
“Histamine” is found in the brain and helps keep you alert and awake. An “anti”-histamine crosses over into the brain and makes you sleepy. Many people take an antihistamine when they have a problem with allergies. In addition to helping treat their allergies, it is also known to make them very sleepy. You may not be sure if your allergy or cold product contains something that can make you sleepy. Ask your doctor or pharmacist in order to be certain.
Antihistamines are the most common ingredient in sleep aids that you can buy at a local drug store. Some versions used include the following:
- Diphenhydramine hydrochloride (also called Benadryl®)
- Diphenhydramine citrate
- Doxylamine succinate (may be in some cold formulas such as Maximum Strength Nytol® or Unisom®)
- Triprolidine hydrochloride (may be found in allergy or cold medications such as Actifed®)
Studies of how antihistamines help people with insomnia have looked at the way patients report the following:
- Their ability to fall asleep and stay asleep
- The number of times they wake up after falling asleep
- Their total sleep time
- The quality of their sleep
Results show that antihistamines do help patients sleep better. The studies included a control group who took a placebo. The placebo was only a sugar pill with no real medicine. The group taking the placebo did not sleep better. The studies covered only one to two weeks of use. The most common side effects included the following:
- Dry mouth
Patients do say that antihistamines help them sleep better. This effect is mild, but positive. Side effects, such as drowsiness during the day, can be common and severe. The effectiveness when used over time has not been studied. These medications may affect the activities of patients the following day. This may lead to other problems.
Other Allergy and Cold Products
Allergy and cold products may contain antihistamines. They may also contain other ingredients that affect sleep. Some of these ingredients may cause sleepiness. An example is dextromethorphan. It is often added to cough and flu products. Other ingredients may have the opposite effect and cause insomnia. An example is pseudoephedrine. This is also called Sudafed®.
Many allergy and cold products have more than one of these ingredients. It is important to read the labels. You may not be sure if your allergy or cold product contains something that can make you sleepy or cause insomnia. Ask your doctor or pharmacist.
Melatonin is a hormone that is released by the brain at night. Many believe that it has a strong link to the sleep-wake cycle. Its release is regulated by an area of the brain that serves as an internal clock. This clock tells the body when it is time to sleep at night. It also tells your body when to be awake during the day. This clock controls “circadian rhythms” in your body. The word “circadian” means to occur in a 24-hour cycle.
The effects of melatonin on sleep have been studied in many ways. Results show the following:
- It may help some people feel sleepy in a mild way. This effect has not been found in all cases.
- It can help people who suffer from jet lag. To be a benefit, it must be taken on the right schedule.
- It can be a big help to people who are blind. They often have an unusual cycle of sleeping and being awake. It can help them have a more normal pattern of sleep.
- The amount of melatonin in your body lowers as you get older. The results of studies in the elderly have not been able to prove that melatonin is helpful.
- It does not help older adults who have dementia to sleep better, except in rare cases.
These studies have found melatonin to be fairly safe in healthy adults. There do not seem to be any serious side effects. But many more tests need to be done. Studies have shown that melatonin can affect reproductive hormones. This is especially true when it is used at high doses. It can also be unsafe if it is used with some kinds of psychiatric medicines. Current studies suggest that melatonin may also be involved in other body systems. One example is the immune system. The effects of long-term use of melatonin are not known.
Studies also show that the timing and amount of the dose are important. This may vary from one person to another. Melatonin products are not regulated by the FDA. They may not have been tested for purity. The ingredients and amounts of melatonin in products may vary.
Melatonin can be a benefit to those who are blind or have jet lag. In other cases, it may have a mild effect, if any at all. The quality of products found on drugstore shelves varies. Melatonin is often mixed with other compounds. More studies are needed to determine its safety. General guidelines for the most effective timing and amount of dose are also needed. No information exists on the long-term effects of melatonin use.
There are many herbal supplements that have been marketed to help treat insomnia.
Some common products contain the following:
- Valerian root
- Passion flower
Less common products may contain the following:
- Jamaican dogwood
- California poppy
- Lemon balm
- St. John’swort
- Kava kava
- Wild lettuce
- Patrinia root
Valerian root is the only one of these that has been studied in any detail. Patients have said that it helps improve the quality of their sleep. There do not appear to be any major side effects. But liver toxicity has been reported.
Many people think that chamomile tea is very relaxing. There is still not a good study to show that it makes you sleepy.
St. John’s wort has been studied for the treatment of depression. It has not been studied for insomnia. St John’swort may interact with many other kinds of medications. This includes drugs used for the heart, breathing, diabetes, and depression. Side effects have included the following:
- Stomach complaints
- Potentially dangerous drug interactions
Patients say that patrinia root improved their sleep in one study. There was not a control group to take a placebo in this study. The most common side effect was stomach uneasiness.
Yoku-kan-san-ka-chimpi-hange (YKCH) is an herbal medicine that seems to have helped increase the total sleep time of healthy adults. It has not been scientifically studied in people with insomnia.
There is no evidence to show that the use of any other herb helps improve sleep. Some herbs can have bad side effects when they are used at high doses or with other medicines.
Jamaican dogwood is highly toxic and should not be used. You can no longer find it in many areas. Products containing kava kava may cause severe liver damage. Both the FDA and the Centers for Disease Control and Prevention (CDC) have noted the risks of products containing kava. They should be avoided.
Valerian root is the only herb with some data to show that it helps treat insomnia. The long-term effects of herbs have not been properly studied. It is unclear what may happen if they are used for more than two weeks. The use of herbs also has the potential to cause bad side effects. Herbs may interact with other medicines or with other herbs. Like melatonin, the quality of products may vary. The herb may also be mixed with other ingredients.
More studies are needed to determine how safe and effective herbs are for general use. Their use especially needs to be studied for more than a few weeks.
Many people think that alcohol will help them fall asleep faster. How fast it helps you fall asleep varies. How it helps the quality of your sleep also differs. It depends upon how much alcohol you drink and how long it is used. At first, alcohol will make you sleepy and shorten the time it takes for you to fall asleep. Over time, it can make your sleep worse. It causes you to wake up multiple times during the night. Late at night, you will spend more time awake. You will also spend less time in deep sleep. The effect that it has on people with insomnia has not been studied.
There are harsh effects on the mind and the body when too much alcohol is used. The frequent use of large amounts of alcohol can disrupt sleep and make insomnia worse. It can also increase problems with snoring and sleep apnea.
At first, alcohol can lead to a decrease in the time it takes to fall asleep. Over time, it seems to make insomnia worse. It makes you wake up and keeps you from enjoying as much deep sleep. It also increases snoring and sleep apnea. Heavy use of alcohol can also be harmful to your overall health.
Vitamins and Minerals
Many vitamins have been said to help you sleep better. These include the following:
- Vitamin A
- Vitamin B12
No careful studies have shown that they help you sleep better in any way . Patients with kidney failure were studied as they took calcium . High levels of calcium actually caused them to have insomnia.
Niacin might help you sleep better. But there is still no data to show that it helps with insomnia. Niacin may cause you to have flushing, an upset stomach, and itching. It may interact with other medications such as statins. It can also interact with herbs such as kava and valerian.
Iron (ferrous sulfate) may help some people who have trouble falling asleep due to restless legs syndrome. But you should first talk to your doctor. He or she may want to do blood tests. Iron can cause nausea and constipation. It cannot be taken at the same time as certain medications. Iron can also interact with some medications.
A high level of vitamin A is toxic and should be avoided. It can make you sleepy, sluggish, and grouchy. It can also give you an irresistible need to go to sleep. Vitamins A, E, and K can interact with medications such as coumadin . This is a blood thinner medicine.
Magnesium is thought to play a natural role in human sleep. It has a part in the production of melatonin. Melatonin is a hormone that is released by the brain at night. There is no study to show that the use of magnesium helps to treat insomnia. Taking magnesium at high doses may cause problems such as the following:
- Irregular heart beat
Some case reports hint that vitamin B12 may help to treat circadian rhythm disorders. But studies that used a control showed no benefits after four to eight weeks of use.
Natrum muriaticum (Nat mur) is sodium chloride (plain salt). It may help treat nightmares, but it has never been tested for insomnia.
Vitamins and minerals do not seem to be a big help to people with insomnia. There is very little data to support their use. An overdose of some vitamins and minerals can have severe results. High doses should not be taken.
Tryptophan is a basic amino acid. Amino acids are often called “the building blocks of life.” L-tryptophan and 5-hydroxytryptophan are two common offshoots of tryptophan. Your body changes L-tryptophan into serotonin. Serotonin is a chemical messenger in the brain that helps tell your body to sleep. Some studies have shown that L-tryptophan can help you fall asleep faster. The studies showed this in both normal sleepers and those with insomnia. But these results have not been consistent. Tryptophan can be found naturally in dairy products and in foods such as turkey. Right now you can only get L-tryptophan pills with a prescription in the U.S.This is because the methods used to make it in past years contaminated it. Some people became very ill and a few dozen people died after taking tainted samples in 1989. It was removed from store shelves. Since then, tryptophan is generally unavailable in stores. There is very little data to show if 5-hydroxytryptophan is useful. No one has tested it to see if it helps treat insomnia.
Today in the U.S., you can’t buy any legal products from store shelves that contain tryptophan. There is no data to show that buying it in prescription form will help you treat insomnia.
Some studies suggest that the foods you eat can help to treat insomnia. It is thought that the tryptophan in some foods can help make you sleepy. Milk and cheese, chicken and turkey, and beans are examples of foods that have a lot of tryptophan. Some people think that a snack with fat or carbohydrates before bedtime will help you sleep better. Popular choices are apple pie, ice cream, or cookies and milk. The benefits to your sleep of eating these snacks are very small.
Eating near bedtime can cause some people to have heartburn. Drinking extra fluids near bedtime can result in extra trips to the bathroom during the night. Limiting food and fluids near bedtime may decrease the number of times you wake up during the night. This will help you sleep better through the night.
Avoiding drinks that are high in caffeine is an easy first step to improve your sleep diet. Drinks to stay away from in the afternoon and evening include coffee, tea, and soda.
A vegetarian diet has not been found to be a major help for people with insomnia.
The Argonne diet helped improve the sleep of a small military group with jet lag. This diet alternates “feasting” days with “fasting” days for four days before travel. For a feasting day, you eat high protein foods early in the day and high carbs at night. You eat no more than 800 calories on a fasting day. The use of this diet with people who have insomnia has not been studied.
Avoiding stimulants such as caffeine before bedtime is the only change in diet that is sure to help insomnia. No other diets have much data to show that they can be a help.
Most insomnia treatments that you can buy in stores have very little proof that they work and are safe.
A few studies suggest that Valerian root helps you sleep better. The effect is small, but there is an improvement in sleep.
Studies that examine the antihistamine diphenhydramine have shown that it helps improve your sleep. Side effects, especially daytime sleepiness, are often a problem.
Melatonin may help those with insomnia due to jet lag, shift work or blindness.
Overall, there is a lot of research that looks at how Valerian root , melatonin and antihistamines improve sleep. But the evidence to support their use is still very small. The studies are also weak in that they have only looked at short-term treatment. They only study a few days or weeks. It is not known if long-term use is either safe or helpful.
There is not enough data to show that you should treat insomnia with the following:
5-hydroxytryptophan, hops, chamomile, lemon balm, St. John’s wort, niacin, magnesium, B12, dietary changes or YKCH.
No data was found that examines if any of the following are helpful:
passion flower, California poppy, wild lettuce, skullcap, calcium, vitamin A, 5-hydroxytryptophan or natrum muriaticum.
Finally, there can be dangerous side effects related to the use of Jamaican dogwood and kava kava . Jamaican dogwood is toxic to humans. The use of kava kava can cause severe liver damage. Products containing them should be avoided at all times. An L-tryptophan product caused several deaths in 1989. It is no longer available for general use. It is prescribed only for special conditions.
Alcohol does not aid the overall quality of your sleep. It disrupts your sleep and causes you to spend more time awake at night. It can also make both insomnia and sleep apnea worse. Alcohol is dangerous when it is not used in moderation.
Sleep hygiene, behavioral therapies, and prescription sleep aids are the best ways to treat insomnia. They are widely available and highly effective. Nonprescription products such as melatonin and herbs are not regulated by the FDA. Many nonprescription medicines and herbs have not been well studied for any of the following:
- Side effects
- Drug interactions
- Long-term effects
You may not be sure about possible interactions with your current medications. Ask your doctor or pharmacist. You should see your doctor or a sleep specialist if you have an ongoing problem with insomnia. You should also see a sleep specialist if your insomnia causes you to nod off during the day.
Find an accredited sleep center near you.
Reviewed by Sharon L. Schutte-Rodin, MD
Updated on September 22, 2005